Computer-based system to optimize medical treatment based on consumer choice and comparative effectiveness of treatment data

ABSTRACT

Apparatus and methods relating to a memory storing, for a population having different medical treatments, each member of the population&#39;s medical treatment data for at least one of a disease, an ailment, and a disability and corresponding cost data for the medical treatment; a digital computer, which: accesses the memory to obtain the stored data and then processes the stored data, including: grouping the data according to types of the medical treatments received to produce groupings for each said at least one of the disease, the ailment, and the disability; computing, from the groupings of the types of treatments received, to produce a measure of comparative cost effectiveness of the medical treatments; and applying the measure to the population produce a comparative effectiveness of the medical treatments; generating output which includes the produced the comparative effectiveness of the medical treatments; and an output device which disseminates the output.

I. PRIORITY STATEMENT

The present patent application is a continuation of U.S. patentapplication Ser. No. 13/213,983, filed Aug. 19, 2011, issuing as U.S.Pat. No. 8,635,183 on Jan. 21, 2014. Ser. No. 13/213,983 claims benefitfrom Ser. No. 61/521,651, filed Aug. 9, 2011, now expired, and is acontinuation-in-part of Ser. No. 12/763,117, filed Apr. 19, 2010, issuedas U.S. Pat. No. 8,321,372 on Nov. 27, 2012, and incorporates byreference from both for all purposes as if fully set forth hereintherefrom. Ser. No. 12/763,117 claims benefit from Ser. Nos. 61/170,421,filed Apr. 17, 2009, now expired; 61/171,544, filed Apr. 22, 2009, nowexpired; 61/173,319, filed Apr. 28, 2009, now expired; 61/299,615, filedJan. 29, 2010, now expired. Ser. No. 13/213,983 also incorporates byreference for all purposes as if fully set forth herein from Ser. Nos.61/170,421, filed Apr. 17, 2009; 61/171,544, filed Apr. 22, 2009;61/173,319, filed Apr. 28, 2009; 61/299,615, filed Jan. 29, 2010.

II. BACKGROUND OF THE INVENTION

A. Field of the Invention

Process, machine, manufacture, or composition of matter, andimprovements thereof.

B. Summary

Process, machine, manufacture, or composition of matter, andimprovements thereof related to electrical and computer technology.

III. FIGURES

FIG. 1 is an illustrative embodiment.

FIG. 2 is an illustrative embodiment.

FIG. 3 is an illustrative embodiment.

FIG. 4 is an illustrative embodiment.

FIG. 5 is an illustrative embodiment.

FIG. 6 is an illustrative embodiment.

FIG. 7 is an illustrative embodiment.

FIG. 8 is an illustrative embodiment.

FIG. 9 is an illustrative embodiment.

FIG. 10 is an illustrative embodiment.

FIG. 11 is an illustrative embodiment.

FIG. 12 is an illustrative embodiment.

FIG. 13 is an illustrative embodiment.

FIG. 14 is an illustrative embodiment.

FIG. 15 is an illustrative embodiment.

FIG. 16 is an illustrative embodiment.

FIG. 17 is an illustrative embodiment.

FIG. 18 is an illustrative embodiment.

IV. MODES

As used herein, the term “computer” generally refers to hardware orhardware in combination with one or more program(s), such as can beimplemented in software, hardware, or a combination thereof. Computeraspects can be implemented on general purpose computers or specializeddevices, and can operate electrically, optically, or in any otherfashion. A computer as used herein can be viewed as at least onecomputer having all functionality or as multiple computers withfunctionality separated to collectively cooperate to bring about thefunctionality. Logic flow can represent signal processing, such asdigital data processing, communication, or as evident from the contexthereinafter. Logic flow or “logic means” can be implemented in discretecircuits, programmed computer, or the equivalent. Computer-readablemedia, as used herein, can comprise at least one of a tape, a writtendocument (including a “mark-sense” card or an XML document), a RAM, aROM, a disk, a flash drive, an ASIC, and a PROM. Data entry, as usedherein, can comprise at least one of (i) manual entry by at least one ofone or more keyboards, one or more mice, one or more pens, one or moretablets, one or more scanners, one or more voices, one or more movementsor contractions of a body part, one or more body-generated magnetic orelectrical signals, or one or more other manual data entry devices, or(ii) electronic entry through one or more physical or wired attachmentsto computer-readable media or one or more wireless connections tocomputer-readable media, and in each such cases either directly to theentry device or media or indirectly through a LAN or WAN (e.g., theInternet).

Embodiments of herein may be implemented in hardware or software, or acombination of both. Embodiments may be implemented as one or morecomputer programs executing on programmable systems comprising at leastone processor, a data storage system (including volatile andnon-volatile memory and/or storage elements), at least one input device,and at least one output device. Program code may be applied to inputdata to perform the functions described herein and generate outputinformation. The output information may be applied to one or more outputdevices, in known fashion. A processing system embodying the playbackdevice components can include any system that has a processor, such as,for example, a digital signal processor (DSP), a microcontroller, anapplication specific integrated circuit (ASIC), or a microprocessor.

The programs may be implemented in a high level procedural or objectoriented programming language to communicate with a processing system.The programs may also be implemented in assembly or machine language, ifdesired. In fact, the embodiments are not limited in scope to anyparticular programming language. In any case, the language may be acompiled or interpreted language.

The program(s) may be stored on a storage media or device (e.g., harddisk drive, floppy disk drive, read only memory (ROM), CD-ROM device,flash memory device, digital versatile disk (DVD), or other storagedevice) readable by a general or special purpose programmable processingsystem, for configuring and operating the processing system when thestorage media or device is read by the processing system to perform theprocedures described herein. Embodiments may also be considered to beimplemented as a machine-readable storage medium, configured for usewith a processing system, where the storage medium so configured causesthe processing system to operate in a specific and predefined manner toperform the functions described herein.

Some embodiments can be configured along the lines of FIG. 1, or partthereof. Illustratively, then, there can be a processing computersystem, 100, which can (depending on the configuration preferred for aparticular application) include a digital computer, 102 (e.g., an IBM,Hewlett Packard, or other personal computer) with one or more processors(e.g., an Intel series processor or the like), random access memory (notseparately shown), one or more input devices, 104 (e.g., keyboard,mouse, modem, etc.) disk storage, 106 (e.g., hard drive, disk drive, CD,DVD, flash drive, etc.), and one or more output devices, 108 (e.g., aHewlett Packard printer, a Dell monitor, a modem, router, etc.). Therecan be an operating system or other program such as Microsoft XPProfessional (and its applications such as EXCEL, ACCESS, and WORD) torun on the computer system, 100, a word processing system, such asMicrosoft Word to process transaction data, and/or some hard codedsystems to perform the technical processes herein, and produce theoutput data according thereto. So for example, the input device, 104,such as a keyboard can receive the input data either manually or inanother manner, e.g., electronically via an input device such as arouter, which can also be an output device. Output device, 108, can beused for outputting the processed information.

The processing computer 100 may also be connected to other peripherals,110, (e.g., one or more remote computers, a computer network, a webserver or a web page). In addition to the direct input and outputdevices described above, the processing computer 100 may utilize theseperipherals to both receive the data it needs and output the results itcomputes. Some of these peripherals, such as remote computers, webpages, web servers, and telephonic instant text, video and multimediaservices, may also be the source of manual input from one or moreindividuals.

The processing computer 100 can be implemented to handle certain datatypes, such as DATA ABOUT COMPARATIVE TREATMENT EFFECTIVENESS, 200. Theprocessing computer 100 can acquire the data of COMPARATIVEEFFECTIVENESS OF TREATMENT, 210, from various sources, such as,governmental data bases, private research data bases, academic studies,and its own internal data base.

DATA ABOUT DISTRIBUTION, 300, is another data type that can be receivedby the processing computer 100. The processing computer 100 can acquirethe data of DISTRIBUTION DATA FOR DISEASES IN A POPULATION, 310, fromvarious sources, such as, governmental data bases, private research databases, academic studies, and its own internal data base.

DATA OF A POPULATION, 400, is another data type that can be received bythe processing computer 100. The processing computer 100 can acquire thedata of PERSONAL DATA, 410, directly from individuals via a web page, aweb server, a remote computer, via Fax, via mail or via a telephonicinstant text, video and multimedia services. The processing computer 100can acquire the data of PAYER DATA, 420, from private insurance companyor governmental sources. The processing computer 100 can acquire thedata of COMPARATIVE TREATMENT EFFICACY DATA, 430, from COMPARATIVEEFFECTIVENESS OF TREATMENT, 210.

The various data received as described above, illustratively caninclude, but is not limited to:

-   -   Demographic data    -   Health data    -   Behavioral data    -   Geographical data    -   Distribution of diseases    -   Distribution of ailments    -   Distribution of disability    -   Treatment data    -   Demographic data    -   Claims data    -   Behavioral data    -   Clinical data    -   Medical provider data    -   Benefits data    -   Approval data    -   Geographical data    -   Patient testimonial data        with such data input to the processing computer 100 by using one        or more of its input devices, or one or more of the peripheral        devices described above.

The processing computer 100, having received the necessary inputs,computes from the inputs a PROBABILITY OF FUTURE MEDICAL TREATMENTNEEDED BY INDIVIDUAL 1, 500 (FIG. 2). The processing computer 100computes these probabilities FOR A DISEASE, 510, FOR AN AILMENT, 512,and FOR A DISABILITY, 514. The processing computer 100 can produceTAILORED TREATMENT INFORMATION, 520, corresponding to theseprobabilities, including but not limited to:

-   -   Appropriate Surgical Treatments for the Individual's health        condition    -   Appropriate Non Surgical Treatments for the Individual's health        condition    -   Appropriate Alternative Treatments for the Individual's health        condition    -   Risks inherent in each of the above treatments    -   Prognosis for recovery from each treatment    -   Avg. cost of each treatment        The TAILORED TREATMENT INFORMATION, 520 can be outputted, via a        suitable output device as exemplified above, to the appropriate        individuals. For a more particular example, the outputting can        use one of the output devices described above using a        MULTIMEDIA, 522, or by using AUDIO/VIDEO/ANIMATION, 524, format.

The processing computer 100 can compute these probabilities forIndividual 1, and for other individuals, including Individual N. Theprocessing computer 100 computes the PROBABILITY OF FUTURE MEDICALTREATMENT NEEDED BY INDIVIDUAL N, 600. The processing computer 100computes these probabilities FOR A DISEASE, 610, FOR AN AILMENT, 612,and FOR A DISABILITY, 614. The processing computer 100 produces TAILOREDTREATMENT INFORMATION, 620, corresponding to these probabilities,including but not limited to:

-   -   Appropriate Surgical Treatments for the Individual's health        condition    -   Appropriate Non Surgical Treatments for the Individual's health        condition    -   Appropriate Alternative Treatments for the Individual's health        condition    -   Risks inherent in each of the above treatments    -   Prognosis for recovery from each treatment    -   Avg. cost, benefit and any incentive associated with each        treatment

The TAILORED TREATMENT INFORMATION, 620 is outputted to the appropriateindividuals using one of the output devices described above, e.g., usinga MULTIMEDIA, 622, or by using AUDIO/VIDEO/ANIMATION, 624, format.

After receipt of the tailored information 620 as described above, anindividual can indicate a treatment path, e.g., selected, as his or herchoice of treatment using one of the input devices described above. Thisindication, e.g., TREATMENT SELECTION, 700, allows the processingcomputer 100 to compute TREATMENT SPECIFIC PROVIDER INFORMATION, 800,including but not limited to:

-   -   LIST OF PROVIDERS, 810, who provide the selected treatment    -   LIST OF PROVIDERS APPROVED BY PAYER, 820. This is a list of        providers approved by the individual's payer to provide selected        treatments to its insureds.    -   COST, INCENTIVE & BENEFIT ASSOCIATED WITH EACH PROVIDER, 830    -   PROVIDER EXPERIENCE, 840    -   PROVIDER QUALIFICATIONS, 850    -   PROVIDER QUALITY RATINGS, 860

The TREATMENT SPECIFIC PROVIDER INFORMATION, 800, is outputted to theappropriate individuals using one of the output devices described above,e.g., using a MULTIMEDIA, VIDEO, AUDIO OR ANIMATION, 870, format.

After receipt of the provider specific information 800 as describedabove, the individual indicates (e.g., by a selection) a provider as hisor her choice of receiving treatment from using one of the input devicesdescribed above. Upon receipt of this selection, PROVIDER SELECTION,900, the processing computer 100 computes, SCHEDULED APPOINTMENT, 1000,TRAVEL INFORMATION, 1200, LOGISTICAL INFORMATION, 1400. These can beoutputted to the appropriate individuals using one of the output devicesdescribed above, e.g., using a MULTIMEDIA, VIDEO, AUDIO OR ANIMATIONformat.

Further, either by using the previously computed travel and logisticalinformation as above, or by receiving input from the individualregarding his or her alternate travel choice (whereby the processingcomputer computes a new set of logistical information, if appropriate),the processing computer 100 creates an ASSOCIATION OF HEALTHCONSEQUENCES WITH TRAVEL, 1600, using the ASSOCIATION FORMING CRITERIA,1800, including but not limited to:

-   -   TRAVEL DISTANCE, 1810, a measure of distance that can be        traveled safely by the individual without suffering a negative        health consequence    -   TRAVEL DURATION, 1820, a measure of time that can be traveled        safely by the individual without suffering a negative health        consequence    -   METHOD OF TRAVEL, 1830, a method of travel that can be        undertaken safely by the individual without suffering a negative        health consequence    -   SAFETY SCORE, 1840, a numerical determination of the general        suitability of travel by the individual without suffering a        negative health consequence    -   TIME OTHER THAN TRAVEL TIME, 1850, such as, the time recommended        to wait, given current health conditions, before initiating a        travel without suffering a negative health consequence    -   TIME OF REST AFTER TRAVELLING, 1860, such as, the time        recommended for resting by the individual after travelling for a        given duration before resuming the journey without a suffering a        negative health consequence    -   TIME TO WAIT AFTER TRAVEL BEFORE MEDICAL PROCEDURE, 1870, such        as, the recommended time to rest after travel by the individual        before undergoing a medical procedure without a suffering        additional negative health consequences as a result of travel    -   TIME TO WAIT BEFORE TRAVEL AFTER MEDICAL PROCEDURE, 1880, such        as, the recommended time to rest before initiating travel by the        individual after undergoing a medical procedure without a        suffering additional negative health consequences as a result of        travel

The HEALTH CONSEQUENCES (ASSOCIATED WITH EACH ASSOCIATION FORMINGCRITERIA) information, 2000, can be outputted to the appropriateindividuals using one of the output devices described above, e.g., usinga MULTIMEDIA, VIDEO, AUDIO OR ANIMATION format.

After receipt of the HEALTH CONSEQUENCES information 2000 as describedabove, the user can indicate (e.g., by a selection) his or her choice oftravel using one of the input devices described above (FIGS. 3-5). Thisselection, TRAVEL SELECTION, 2100, allows the processing computer 100 toprocess so as to produce as output the final travel selection using oneof the output devices described above, e.g., using a MULTIMEDIA, VIDEO,AUDIO OR ANIMATION format. The processing computer 100 preparesappropriate TRAVEL OUTPROCESSING documents and services, 2100, includingbut not limited to:

-   -   Collect any payment that may be due    -   Generate and receive from individual, necessary informed consent        for medical travel and other similar documents using a        MULTIMEDIA, VIDEO, AUDIO OR ANIMATION format    -   Collect any insurance forms which may need filling up by the        individual prior to travelling    -   Collect any other paper work which may need filling up by the        individual prior to travelling    -   Provide all necessary reservation, visa, passport and other        travel related services to the individual    -   Provide location and other related geographical information        about medical provider    -   Provide appropriate logistical information about medical        provider    -   Provide welcome information from medical provider, including        name and other contact information of an escort, in any, who        will assist the individual during his or her stay to receive        treatment from the medical provider    -   Provide comprehensive statements about medical provider's agreed        upon cost for providing selected treatment and any payments that        may need to be made directly to the medical provider directly.    -   Initiate COLLECTION OF PRE-TRAVEL DATA, 2300, from the        individual about the condition of his or her current health        conditions which may be necessary to compute COMPARATIVE        EFFECTIVENESS OF TREATMENT

The processing computer 100 invokes an INITIATE TRACKING TO BEPERIODICALLY UPDATED OF TRAVELLING INDIVIDUAL'S STATUS process, 2400, bywhich it receives periodic status updates regarding the travellingindividual's current status via one or more of the input devicesdescribed above.

Before the individual is admitted to the provider's facility fortreatment, a COLLECTION OF PREADMISSION DATA, 2500, can made from theindividual about the condition of his or her current health conditionswhich may be necessary to compute COMPARATIVE EFFECTIVENESS OF TREATMENT210.

Following COMPLETION OF TREATMENT, 2600, and e.g., before the individualis discharged from the provider's facility after treatment, a COLLECTIONOF DISCHARGE DATA, 2700, is also made from the individual about thecondition of his or her current health conditions which may be necessaryto compute COMPARATIVE EFFECTIVENESS OF TREATMENT 210.

After RETURN HOME AFTER TREATMENT status, 2800, is detected, indicatingthat the individual has successfully returned home, the ProcessingComputer can initiate a COMPLETE ALL NECESSARY FOLLOW UP MEDICAL CARE,IF ANY, 2900, process.

The COMPLETE ALL NECESSARY FOLLOW UP MEDICAL CARE, IF ANY, 2900, processensures, by examining periodic status updates received from one or moreinput devices as described above, that the individual completes allnecessary follow up cares as may or may not be necessary for him or her,given his or her current health condition.

Following completion of medical follow up care, the COLLECTION OFPERIODIC DATA process, 3000, can be initiated whereby data isperiodically collected from the individual about the condition of his orher current health conditions which may be necessary to computeCOMPARATIVE EFFECTIVENESS OF TREATMENT 210.

After each collection of periodic health status data, a COMPUTATION OFCOMPARATIVE EFFECTIVENESS OF TREATMENT RECEIVED, 3100, can be conducted.This can result in the triggering of an UPDATING OF COMPARATIVEEFFECTIVENESS OF TREATMENT process, 3200, whereby the PROCESSINGCOMPUTER'S MEMORY, 3300, is updated.

Turn now to FIGS. 6-18 for further embodiments and articulations of theforegoing. With respect to a population of employees of an employer (forexample), members of a health insurance plan and/or other such payers ofhealthcare costs, such as the US Government, consider that astatistically determinable number of members of such populations willgenerally require or best have surgical treatments or other majormedical interventions for a variety of ailments, often as treatments oflast resort; consider however, that for some of those ailments,disability and disease conditions, referenced herein as “preferencesensitive conditions,” and for some of these individuals, treatmentalternatives to surgeries or other major medical interventions,including more limited-scope invasive procedures in some cases, are alsoavailable which will yield acceptable and satisfactoryoutcomes—especially if such alternative treatments, including morelimited-scope invasive procedures where appropriate, are administeredearly enough in the disease or disability phases of the afflictedmembers. Also, consider that based on Comparative Effectiveness ofTreatment data, it is further possible to identify these alternativetreatments, including more limited-scope invasive procedures whereappropriate, to be ranked for best efficacies. Recognize therefore thatin order for these alternative treatments, including more limited-scopeinvasive procedures where appropriate, to have the best chance forsuccess in avoiding surgery or other major medical interventions, it maybe best in some applications to first identify potential members, thenintervene and administer such treatments at the right phases of themembers' disease or disability progressions. Interventions that areinitiated too early may statistically yield too many false alarms orinterventions and interventions that are administered too late and/orwhen the diseases or disabilities have progressed too far, will not helpavoid the need for ultimate surgical or other major medicalinterventions treatments. Consider FIG. 6.

An embodiment herein can facilitate the appropriate administration ofsuch alternative treatments, including more limited-scope invasiveprocedures where appropriate, e.g., by identifying which specificailments, disability and disease conditions are preference sensitive;establishing a set of early indicators of surgery or other major medicalinterventions, which indicators may be of clinical, behavioral, or anyother data type(s) by which to reasonably identify those members of thepopulation who are suffering from preference sensitive conditions andwho have thus become likely candidates to require or best have surgeryor other major medical interventions in the future unless appropriateinterventions can be administered before surgery or other major medicalinterventions becomes unavoidable; by using the early indicators ofsurgery or other major medical interventions to analyze claims or othercomparable data sets, such as psychographics data including but notlimited to the levels of education, occupation, learning styles,languages spoken, ethnicity, religion, etc., to identify targetpopulations of such members for direct intervention; and by identifyingthe appropriate phases in the members' disease or disabilityprogressions when to administer the alternative treatments for besteffectiveness; and by intervening at the appropriate time.

In an embodiment herein, there can be an evaluation (by the computerusing one or more pre-programmed models) of available information aboutthe health status and claims history of the payers' members regardingany initial health conditions and/or diagnoses which have beendetermined with some statistical probability to lead to surgeries orother major medical interventions, medical condition and/or severity ofthe ailment, co-morbidity, other clinical information, demographicinformation, statistical information, and/or other relevant information,as well as any combination of these kinds of information, against aknowledge base containing information about the appropriateness andcomparative efficacies of various available treatments, including morelimited-scope invasive procedures, their possible complications and/oroutcomes statistics or other information about the expected prognosisfor improving the medical conditions by using the potential alternativetreatments, including more limited-scope invasive procedures, and thecorrect phases of the progression of the diseases, disabilities and/orailments when to apply these alternative treatments, including morelimited-scope invasive procedures where appropriate, for besteffectiveness.

One embodiment of one pre-programmed model referred to in section 41above may include the following functional subcomponents in itsimplementation: Data Flow, Source Data, Staging Data, StagingPre-Processing, Data Load Process, Business Logic for Reports, DiagnosisAnalysis, Procedure Analysis, DX/Procedure Analysis Findings, DatabaseTable Structure, Database Views. These subsystem may be furtherdescribed as follows:

Data Flow

FIG. 7 represent the data flow process for producing the analysisreports contained in the CIA application.

The three major layers of the application are:

-   -   1. Source data supplied by the client.    -   2. CIA application and database structures to store and process        the source data.    -   3. CIA reports which apply business logic against the source        data to produce analysis reports.

Source Data

Client data is received as CSV files and loaded into a claims stagingtable. The staging table contains all attributes that could be receivedby a client. The source data is loaded using Oracle's data loadingSQL*Loader utility. Each client file has it's own control file used tomap the source data to the staging table.

Staging Data

The staging table contains source data that was loaded. The stagingtable CLAIMS is where all pre-processing is done to check for errors andto standardize the data.

Staging Pre-Processing

The following transformations are applied to the staging data.

-   -   1. Compare the receive date with the FROM date of service (DOS).        If the FROM DOS is blank then use the receive date. If the FROM        DOS is greater than the receive date then use the receive date.    -   2. Compare the receive date with the TO date of service (DOS).        If the TO DOS is blank then use the receive date. If the TO DOS        is greater than the receive date then use the receive date.    -   3. Assign a line number to the claim when line numbers are        missing.    -   4. Trim all blank spaces from the diagnosis codes and procedure        codes.    -   5. Upper case patient names.

Data Load Process

FIG. 8 illustrates the data loading process may include extractinggroups of information and loading it into separate tables in thedatabase. The client table is used in the process as a reference onlyand is required to have an entry prior to the data loading process. Thedata loading process takes all unique persons and creates or updatesdata in the person table. The person is assigned a unique internalnumber and that number is used to link all claims for a specific person.

The data loading process takes all unique claims and breaks it into aheader record and a claim line record. Each claim header and claim lineis assigned a unique ID. This ID is used to link claims lines to aspecific claim. As the claim record is created the unique person key isassociated with the claim for referential data integrity.

Once all data has been loaded an audit record is created to representthe data the load took place and the number of records loaded. Thesource data is also archived into a source archive table, which is astructural copy of the CLAIMS table.

Business Logic for Reports

The business logic is applied against the claims data using referencedata and database views. The reference data contains the measurementsused in calculating the indicators for surgery based a specificcondition. Each condition contains a set of codes (ICD9 and Procedure)used in the prediction analysis. Each code has a weight associated withit based on the designation of the code relative to the claim. These canbe primary, secondary, tertiary and quaternary. Specific codes are alsoadded to denote “Do Not Call” codes, which are applied to the logic postanalysis.

Diagnosis Analysis

FIG. 9 illustrates the flow which is used to perform the predictionanalysis. Each claim header record is analyzed to extract all codes foreach category that matches the CODESET_WEIGHT reference data for eachdiagnosis (ICD9) code. A separate view is used to classify the codesthat are matched against the code set weights for each ICD9 for eachpatient.

Each view is then aggregated together to produce a single view of eachICD9 code matched for a patient as shown in FIG. 10.

The following business logic illustrated by FIG. 11 is applied duringthe aggregation.

-   -   1. When the ICD9 count for a specific code is greater than 1        then the scaled weight for this code is calculated by taking the        sum of the weight for that code divided by the total count of        occurrences and then multiplied by the defined code multiplier.    -   2. When the ICD9 count for a specific code equals one then the        scaled weight for this code is calculated by taking the sum of        the weight for that code divided by the total count of        occurrences

The DX detail data is then aggregated to produce a total count andweight per DX code per patient.

Procedure Analysis

The following is used in the analysis relative to procedure codescontained on claim lines.

The detail view contains all procedure codes that match the referencedata for a specific patient with the total count and weight for eachcode. It is illustrated by FIG. 12.

This detail data is then aggregated to produce the sum of the procedurecode weights and counts for each patient. The following business logicis applied during the aggregation process as shown in FIG. 13.

-   -   1. When the procedure count for a specific code is greater than        1 then the scaled weight for this code is calculated by taking        the sum of the weight for that code divided by the total count        of occurrences and then multiplied by the defined code        multiplier.    -   2. When the procedure count for a specific code equals one, then        the scaled weight for this code is calculated by taking the sum        of the weight for that code divided by the total count of        occurrences

DX/Procedure Analysis Findings

Each summary (DX summary and Procedure summary) is merged together asshown in FIG. 14 to calculate the findings for each patient. Thisfinding view denotes whether or not the DX scaled weight and procedurescaled weight for each code is greater than the defined thresholdsetting in the reference data. If the threshold is met then it is markedas a candidate based on DX finding, procedure finding, or a combination(meets both DX and procedure finding).

Variance Analysis

A view is created that uses the logic in the Analysis findings to bucketthe patients that have a combination finding into nine categories.

-   -   The NORMAL 90 represents those that have both a DX finding and a        procedure finding greater than the threshold as defined in the        code set weight reference data.        -   DX weight>DX code threshold        -   AND        -   procedure code weight>procedure code threshold    -   The NORMAL 50 represents those that have both a DX finding and a        procedure finding greater than the threshold minus the variance        as defined in the code set weight reference data.        -   DX weight>DX code threshold−variance        -   AND        -   procedure code weight>procedure code threshold−variance    -   The NORMAL 20 represents those that have both a DX finding and a        procedure finding greater than the threshold minus (2 times the        variance) as defined in the code set weight reference data.        -   DX weight>DX code threshold−(2*variance)        -   AND        -   procedure code weight>procedure code threshold−(2*variance)    -   The PLUS 90 represents those that have both a DX finding and a        procedure finding greater than the threshold plus the variance        as defined in the code set weight reference data.        -   DX weight>DX code threshold+variance        -   AND        -   procedure code weight>procedure code threshold+variance    -   The PLUS 50 represents those that have both a DX finding and a        procedure finding greater than the threshold plus the variance        minus the variance as defined in the code set weight reference        data.        -   DX weight>(DX code threshold+variance)−variance        -   AND        -   procedure code weight>(procedure code            threshold+variance)−variance    -   The PLUS 20 represents those that have both a DX finding and a        procedure finding greater than the threshold plus the variance        minus (2 times the variance) as defined in the code set weight        reference data.        -   DX weight>(DX code threshold+variance)−(2*variance)        -   AND        -   procedure code weight>(procedure code            threshold+variance)−(2*variance)    -   The MINUS 90 represents those that have both a DX finding and a        procedure finding greater than the threshold minus the variance        as defined in the code set weight reference data.        -   DX weight>DX code threshold−variance        -   AND        -   procedure code weight>procedure code threshold−variance    -   The MINUS 50 represents those that have both a DX finding and a        procedure finding greater than the threshold minus the variance        minus the variance as defined in the code set weight reference        data.        -   DX weight>(DX code threshold−variance)−variance        -   AND        -   procedure code weight>(procedure code            threshold−variance)−variance    -   The MINUS 20 represents those that have both a DX finding and a        procedure finding greater than the threshold minus the variance        minus (2 times the variance) as defined in the code set weight        reference data.        -   DX weight>(DX code threshold−variance)−(2*variance)        -   AND        -   procedure code weight>(procedure code            threshold−variance)−(2*variance)

Database Table Structure

The following are the Data Structure used:

CLAIMS (Staging table) ID CLIENT_KEY GROUP_NO CLAIM_NO LINE_NO FROM_DOSTO_DOS POS TOS PROVIDER_TAXID PROVIDER_NPI PROVIDER_CERTPROVIDER_FIRSTNAME PROVIDER_MI PROVIDER_LASTNAME PROVIDER_OFFICE_NAMEPROVIDER_SPECIALTY PROVIDER_ADDRESS_1 PROVIDER_ADDRESS_2 PROVIDER_CITYPROVIDER_ST PROVIDER_ZIP INSURED_ID RELATIONSHIP_CODE PATIENT_IDPATIENT_LASTNAME PATIENT_FIRSTNAME PATIENT_MI PATIENT_SSN PATIENT_SEXPATIENT_DOB PATIENT_ADDRESS_1 PATIENT_ADDRESS_2 PATIENT_CITY PATIENT_STPATIENT_ZIP PATIENT_PHONE PATIENT_EMAIL ICD9_1 ICD9_2 ICD9_3 ICD9_4PROCEDURE LOINC REVENUE_CODE MODIFIER1 MODIFIER2 MODIFIER3 PROCEDURE_1PROCEDURE_2 PROCEDURE_3 PROCEDURE_4 PROCEDURE_5 PROCEDURE_6 DRGADMIT_DIAG CLAIM_TYPE TOTAL_BILL TOTAL_PAID CLAIM_DATE PATIENT_ALT_PHONELOADED_FLAG PERSON_KEY ERROR_MSG CLAIM_HEADER_KEY LOAD_ID RECEIVE_DATEFROM_DOS_ADJUSTED TO_DOS_ADJUSTED FROM_DOS_ORIGINAL TO_DOS_ORIGINALCLIENT CLIENT_KEY CLIENT_NAME MIN_DOS MAX_DOS DOS_DAYS PERSON PERSON_KEYLASTNAME MI FIRSTNAME ADDRESS1 ADDRESS2 CITY STATE ZIP SSN GENDER DOBCLIENT_KEY CERT GROUP_NUM PHONE_NUM ALT_PHONE_NUM EMAIL_ADDR PATIENT_IDCREATED_BY CREATED_DT UPDATED_BY UPDATED_DT RELATIONSHIP_CD CLAIM_HEADERCLAIM_HEADER_KEY CLAIM_NO DOS_FROM DOS_TO PROVIDER_FNAME PROVIDER_MIPROVIDER_LNAME PROVIDER_ID PROVIDER_OFFICE PROVIDER_ADDRESS1PROVIDER_ADDRESS2 PROVIDER_CITY PROVIDER_STATE PROVIDER_ZIP PROVIDER_NPIPATIENT_LASTNAME PATIENT_MI PATIENT_FIRSTNAME PATIENT_ADDRESS1PATIENT_ADDRESS2 PATIENT_CITY PATIENT_STATE PATIENT_ZIP PATIENT_SSNPATIENT_GENDER PATIENT_DOB CLAIM_TYPE ICD9_1 ICD9_2 ICD9_3 ICD9_4CLIENT_KEY PERSON_KEY CREATED_BY CREATED_DT UPDATED_BY UPDATED_DTLOAD_ID GROUP_NO CLAIM_DT CLAIM_LINE LINE_NO PROC REV MOD1 MOD2 MOD3UNITS PROC_1 PROC_2 PROC_3 PROC_4 PROC_5 PROC_6 DRG CLAIM_LINE_KEYCLAIM_HEADER_KEY CLIENT_KEY CREATED_DT CREATED_BY UPDATED_DT UPDATED_BYLOAD_ID DOS_FROM DOS_TO PERSON_KEY CLAIM_DT CONDITION LABEL CREATED_BYCREATED_DT UPDATED_BY UPDATED_DT DESCRIPTION CONDITION_KEYDIAGNOSIS_THRESHOLD PROCEDURE_THRESHOLD DOS_DAYS VARIANCEDIAGNOSIS_MULTIPLIER PROCEDURE_MULTIPLIER CATEGORY CODESET_WEIGHTCODESET_WEIGHT_KEY CONDITION SPECIALIZATION CODESET CODE DESCRIPTIONECODE_FLAG PRIMARY_WEIGHT SECONDARY_WEIGHT TERTIARY_WEIGHTQUATERNARY_WEIGHT DISCOUNT_WEIGHT DNC_CODE

Database Views

The following are the Database Views:

See Ser. No. 61/521,651, incorporated by reference.

In another embodiment, using the early indicators for surgery or othermajor medical interventions as described herein, there can be a computeridentification made of those members of the population who are likelycandidates for surgery or other major medical interventions but whoseconditions are also preference sensitive and surgery or other majormedical interventions may be avoided by appropriately administeringalternative treatments, including more limited-scope invasive procedureswhere appropriate; further, once identified, such members can then bemonitored by the computer for the progression of their diseases,disabilities or ailments.

In another embodiment, once a member suffering from a preferencesensitive condition is identified and monitored by the computer enters aphase in the progression of his or her disease, disability and/orailment where non-surgical or inexpensive treatment alternatives,including more limited-scope invasive procedures if appropriate, can beadministered to have the best chance of ultimately avoiding surgery orother major medical interventions, an intervention can be automaticallytriggered.

In a further embodiment, there can be computer managed matchinginstructions about meeting an alternative treatment physician or anotherhealth practitioner regarding the alternative treatment path selection,including more limited-scope invasive procedures if appropriate.

In another embodiment, to maximize the medical benefits at an optimumcost to the individual, there can be computer managed counselingregarding the individual's alternative treatment options, including morelimited-scope invasive procedures where appropriate, as well as lowercost surgical or other alternatives from competing members of the sameor from another provider network where available.

In yet another embodiment, there can be computer-assisted arrangementsto help the individual with logistics, medical appointments, and/orother arrangements of traveling to the destination of his or her choicefor the selected alternative treatment—including more limited-scopeinvasive procedures where appropriate, available and selected—by ahealthcare provider or healthcare providers at a facility not located inthe individual's home area.

Though the embodiments herein pertain to process, machine, manufacture,or composition of matter, and improvements, to be succinct, considerrepresentatively a process of identifying, by establishing and thenutilizing a set of early indicators of possible future surgeries orother major medical interventions, those individuals of a population whoare suffering from preference sensitive conditions and whose diseases,disabilities and/or ailments have progressed enough to receivealternative treatments, including more limited-scope invasive procedureswhere appropriate, for best effectiveness and who are consequently goingto make informed decisions about, or agree to such treatments. Morespecifically, consider computer-related and implemented systems relatingto the capability of automatically analyzing the claims data and/orother similar clinical information of a member population to identifyand monitor those who exhibit certain medical conditions, disability orailments, or those individuals who have been specifically diagnosed withpreference sensitive conditions or ailments, which conditions and/orailments generally lead to surgeries or other major medicalinterventions in the future if not treated appropriately and at thecorrect phases of progression; and consider in some embodiments, acapability to identify the correct phase when to administer theappropriate alternative treatments, including more limited-scopeinvasive procedures where appropriate; and in some other embodiments, acapability of automatically guiding the individual through the necessaryeducation, information, and a guidance process so he or she can make aninformed decision about receiving the treatment in consultation with hisphysician and/or other health practitioner, while in other embodiments,assisting the individual in making a final cost-benefit analysis,choosing the location and/or physician or other health practitioner toreceive treatments from, as well as arranging for his or her travellogistics and medical appointments, especially when the treatmentfacility is located outside the individual's home area.

Now consider as illustrative a discussion in view of FIGS. 6-18, etc.Embodiments can implement a capability, by first establishing and thenutilizing a set of early indicators of surgery or other major medicalinterventions, of identifying, monitoring and assisting individualschoose a final course of his treatment and travel to any location toreceive the treatment, as exemplified above. Embodiments may be distinctor in combination with clinical screening or matching systems, such assuitability of non-surgical treatments, including more limited-scopeinvasive procedures where appropriate, in view of the individual'sdemographic and/or medical conditions, including severity of ailment,co-morbidity, and other factors. Embodiments can provide earlyidentification and monitoring of a target population, guidance,scheduling, education, information and counseling about availablealternate treatments, if any, including outcomes statistics, ComparativeEffectiveness of Treatment data, or other information about the expectedprognosis for improving the medical condition and probability ofcomplications of each treatment. There shall also be a capability ofperforming appropriate cost benefit analysis given the limits and anyincentives of the insurance policy of the individual. In someembodiments, there shall also be a capability of physician or otherhealth practitioner appointment, treatment scheduling, ticketing andother logistics of traveling if the final treatment is to be receivedfrom a location away from the individual's home area.

As illustrated in FIG. 6, some embodiments can be represented by a flow,6000, in which an individual is first identified as a candidate forearly intervention, 6010, the progression of his disease conditionand/or ailment is then monitored, 6020, to determine when best tointervene with the appropriate alternative treatment, 6030, includingmore limited-scope invasive procedures, 6040, where appropriate, or whenbest to offer surgery or other major medical interventions, 6050, thenhe receives guidance, education, counseling, cost benefit analysis,treatment, physician and/or other health practitioner selection,scheduling, and travel services.

As should also be noted with respect to FIG. 6, an embodiment can have acapability of resulting in an effective management of the process ofidentification, monitoring, providing guidance, education, counseling,cost benefit analysis, treatment, physician or other health practitionerselection, scheduling, and travel services, 6060.

Consider too that for an embodiment to properly manage the process asexemplified above, the system should receive the appropriate amounts andtypes of data. While the types and amounts of data will reflect to adegree the particular embodiment or implementation as may be preferred,and can vary from time to time based on the contemporary state ofunderstanding of the relative efficacy of the various types of earlyindicators of surgery, effective non-surgical alternative treatments,including more limited-scope invasive procedures where appropriate, whento administer such treatments for best effects, of improvedunderstanding of human physiology and development of newer treatments,in one embodiment, there can be a capability of processing and/ortransforming data corresponding to the individual's severity of themedical condition, disease, disability or ailment and other clinicalinformation, demographic information, statistical information,comparative treatment efficacy information, other relevant information,as well as any combination of these kinds of information (FIG. 15).

Embodiments herein can be implemented via a web site linking thecomputer system with another computer system corresponding to theindividual. A further embodiment can implement one of the embodimentsherein as a prerequisite to honoring an insurance claim orpre-authorizing insurance coverage and receiving claims data related tothe treatment, procedure and claims history, and there can becomputer-to-computer communication with an insurance computer system tocarry out this function.

Note too that the embodiments are not limited so as to be devoid ofhuman steps, and in some cases as may be desired, some implementationsmay be carried out by a human emulating a computer operation.

Consider then, representatively, that there can be one or moreembodiments including a computer system comprising a digital computeroperably associated with an input device, a memory, and an outputdevice, the computer programmed to carry out operations including:loading the memory with information about which diseases, ailments andmedical conditions are preference sensitive; receiving at the computervia the said input device, data corresponding to preference sensitiveconditions and their associated co-morbidity, severity and/or otherclinical conditions, demographics information, statistical information,comparative treatment efficacy information or any combination ofthereof; processing the data with the computer so as to produce detailedmaps of the progression of preference sensitive conditions as a functionof co-morbidity, severity and/or other clinical conditions, demographicsinformation, statistical information, or any combination of thereof,from initial diagnoses and/or initial display of disease symptoms up tothe point where alternative, non-surgical treatments, including morelimited-scope invasive procedures where appropriate, remain viabletreatments to ultimately avoid surgeries or other major medicalinterventions; processing the data with the computer so as to producedetailed maps of the progression of preference sensitive conditions as afunction of co-morbidity, severity and/or other clinical conditions,demographics information, statistical information, comparative treatmentefficacy information or any combination of thereof (FIGS. 15-18), frominitial diagnoses and/or initial display of disease symptoms to thepoint where surgical or other major medical interventions becomeunavoidable; processing the matching sets of maps thus produced for eachpreference sensitive condition as a function of co-morbidity, severityand/or other clinical conditions, demographics information, statisticalinformation, comparative treatment efficacy information or anycombination of thereof, to establish a zone of progression of thedisease and/or ailment that may be deemed too early, or pre-mature, fortreatment interventions to be cost effective; processing the matchingsets of maps produced above for each preference sensitive condition as afunction of co-morbidity, severity and/or other clinical conditions,demographics information, statistical information, comparative treatmentefficacy information or any combination of thereof, to establish anoptimum zone of progression of the disease, disability and/or ailmentthat may be deemed most cost effective in avoiding surgical or othermajor medical interventions in the future by initiating alternative,non-surgical treatments, including more limited-scope invasiveprocedures where appropriate, 7000; processing the matching sets of mapsproduced above for each preference sensitive condition as a function ofco-morbidity, severity and/or other clinical conditions, demographicsinformation, statistical information, comparative treatment efficacy orany combination of thereof, to establish a zone of progression of thedisease, disability and/or ailment that may be deemed too late andineffective in avoiding surgical treatments in the future by initiatingany type of alternative, non-surgical treatment interventions or morelimited-scope invasive procedures, 7010; producing, at said outputdevice for each preference sensitive condition, output identifying thethree disease intervention zones as follows: (1) a zone of prematureintervention (7020); (2) a zone of optimum intervention (7000), and (3)a zone of ineffective intervention where interventions are deemed to betoo late to prevent surgery or other major medical interventions in thefuture (7010); and analyzing by the computer, the characteristics of thethree disease intervention zones identified above to establish earlyindicators of surgery or other major medical interventions, a set ofquantitative, descriptive or other measures, or any combination of thesemeasures, by which to uniquely, effectively and/or fully identify eachdisease zone; producing, at said output device, for each preferencesensitive condition, output identifying the early indicators of surgeryor other major medical interventions.

Viewed differently, there can be an apparatus including a first computersystem comprising a digital computer operably associated with an inputdevice, a memory, and an output device, the computer programmed to carryout operations including: receiving at the computer, from informationinput at said input device, data about early indicators of surgery orother major medical interventions; receiving at the computer, frominformation input at said input device, comparative treatmenteffectiveness, insurance claims or other similar data corresponding toan insurance company's historical claims payment, or other similar datacorresponding to other sources of historical medical data, and/ortreatment related information, appropriate health records and/or acombination thereof about members or other individuals; processing theinput data with the computer so as to produce a determination of howmany and which individual members are specifically in each of the threezones of preference sensitive disease progression, thereby determining atarget list of individual members for the most cost effective treatmentinitiations; and producing, at said output device, output disclosing thedetermination.

Such embodiments can further include a second computer system comprisinga second digital computer operably associated with a second inputdevice, a second memory, and a second output device, the second computerprogrammed to carry out operations including: receiving at least some ofthe output disclosing the determination.

Also in such embodiments, the communicating operation can be carried outvia a web site.

And in such embodiments, the first computer can generate further outputreferring an individual to an appropriate medical counselor orconsultant associated with an alternative non-surgical treatment,including more limited-scope invasive procedures where appropriate,corresponding to the determination.

Notably, in such embodiments, the computer can generate other output soas to facilitate the individual choosing a most cost effective facilityand physician for a treatment corresponding to the determination, saidother output reflecting at least one of a measure of quality of aphysician and/or facility, a success rate of the physician and/orfacility, an outcome statistic for alternative treatment, including morelimited-scope invasive procedures where appropriate, a prognosis forimproving the medical condition from the specific treatment, comparativetreatment efficacy or any combination thereof, and any benefit and/orany incentive available from an insurance company, an employer or anyother source for payment for the treatment.

Also, in such embodiments, the computer can generate additional outputso as to facilitate logistics and arrangements for traveling to thelocation chosen by the individual for a treatment corresponding to thedetermination.

And in such embodiments, the computer can generate yet further outputincluding a counseling and education session for each of the treatments.

Note further that in such embodiments, the session can compriseproviding information regarding the terms of insurance coverage, risk ofcomplication, prognosis, or combination thereof for improving themedical condition from each of the alternatives.

Also, in such embodiments, the session can include a selection of afinal treatment corresponding to the determination, includingfacilitating a choice of a most cost effective facility and/or physicianfor the treatment.

And note that in such embodiments, the selection can be formulated asbased upon at least one of: quality and success rate of a physicianand/or facility, benefits and any incentives available from an insurancepolicy or any other source.

In such embodiments, the selection can be for a non-surgical treatment,or more limited-scope invasive procedures where appropriate, generatingoutput helping the individual choose the most cost effective facilityand/or health practitioner for the selected treatment.

In embodiments, there can be receiving data corresponding to: anindividual's disease and/or ailment, any diagnosis, severity andco-morbidity information, demographics information, statisticalinformation, or any combination thereof; data corresponding toavailability of alternate treatments, comparative treatment efficacy,possibility of complication, if any, at least one prognosis forimproving the medical condition from each said treatment; at least onetreatment option; price, quality, and outcome information correspondingto at least one treatment facility and at least one associated healthpractitioner; and coverage, limit, and any incentive offered by theindividual's insurance company, employer or by any other source.

Another illustrative way of embodiment viewing is as a process of usingan apparatus, the process comprising: providing first computer systemcomprising a digital computer operably associated with an input device,a memory, and an output device; loading the memory with informationabout surgical and alternative treatments available for human ailments,including corresponding possibilities of complications and prognosis forimproving the medical condition from each treatment for the ailment as afunction of co-morbidity and severity; comparative treatment efficacy,loading the memory with educational and informational modules aboutalternate treatment choices for each of the ailments and correspondingpossibility of complications, if any, and a prognosis for improving themedical condition; loading the memory with price, quality, and outcomeinformation about treatment facilities and at least one associatedhealth practitioner where each of the treatment choices is available;receiving at the computer, from information input at said input device,data corresponding to an individual's ailment, any initial diagnosis,medical condition including co-morbidity and severity information,demographics information, statistical information, or any combination ofthe information plus information about any insurance or other benefitcoverage limits and incentives relating to the individual; andproducing, at said output device, output disclosing the determination.

Any embodiment herein can also be viewed from the perspective of anarticle comprising: a computer-readable media tangibly embodying aprogram of instructions executable by a computer to perform theoperations corresponding to the embodiment at issue.

Turn now to FIG. 17 for another perspective. With respect to anindividual suffering from a serious ailment who has received an initialdiagnosis of needing surgical or other major medical interventions andwho is consequently going to make an informed decision about, or agreeto, the remaining course of his or her treatment(s), considerembodiments applicable to the process of his or her understanding anddecision making. In one example, consider such decision making as havingconsidered guidance, counseling, education, information, and otherassistances, e.g., at layman levels, so his or her choices can beoptimized based upon available treatment options, risks of complicationsand/or prognosis for recovery from each possible treatment. Consideralso that he or she needs or wishes to properly understand the limit ofhis or her insurance coverage and any incentives therein, includingavailable choice of physicians and alternate locations to receivetreatments, an appropriate cost-benefits analysis, or other suchinformation. An embodiment herein can facilitate an individual'sunderstanding and decision making applicable to such a situation, e.g.,by first using the initial diagnosis, disease condition and severity,co-morbidity, other clinical information, demographic information,statistical information, comparative treatment effectivenessinformation, and/or other relevant information, as well as anycombination of these kinds of information, and then judging if theindividual's condition is a preference sensitive one, i.e., if he or shesuffers from a condition for which appropriate alternate treatment(s) tosurgery or other major medical interventions are available withcomparable recovery prognosis, and how much he is covered for eachalternate treatment under the terms of his or her insurance policy; andthen, if his condition is judged not to be preference sensitive,referring him or her to an appropriate surgical or other major medicalintervention consultant. Embodiments can follow this with appropriatecounseling about the specific surgery or other major medicalinterventions recommended by the surgical or other major medicalintervention consultant so the individual can choose the most costeffective location and/or surgeon for the surgery or other major medicalintervention, e.g., based upon the quality and success rate of thesurgeon or other major medical intervention provider, the benefits andany incentives available from his or her insurance policy. Embodimentscan also facilitate the individual's preparing for the surgery or othermajor medical interventions itself, maximizing the benefits of thesurgery or other major medical interventions by properly complying withpre and post treatment instructions; assisting with the logistics andother arrangements of traveling to the destination (e.g., of his or herchoice) for surgery or other major medical interventions (e.g., if it isnot located in the patient's home area); on the other hand, if theindividual's condition is judged to be preference sensitive, thenguiding him or her through an appropriate counseling and educationprocess for each of the alternative treatments that is available underthe terms of his or her insurance coverage, the risks of complicationsand prognosis for recovery from each of the alternatives, and otherwisepreparing him or her to discuss treatment options next in an informedmanner with the physician counselor, e.g., to select a final course oftreatment; then if the selection is for a surgical or another majormedical intervention path, as before, helping him or her choose the mostcost effective location and/or surgeon for the surgery (e.g., based uponthe quality and/or success rate of the surgeon, the benefits and anyincentives available from his or her insurance policy). Embodiments canalso facilitate the individual's preparing for the surgery or othermajor medical intervention itself so he or she can be a very informedpatient, maximizing the benefits of his surgery or other major medicalinterventions by properly complying with pre and post treatmentinstructions; assisting him or her with the logistics and otherarrangements of traveling to the destination (e.g., of his or her choicefor surgery (e.g., if it is not located in the patient's home area); onthe other hand, if the treatment path selected is non-surgical innature, then helping the individual choose the most cost effectivelocation, and/or the physician for the selected treatment (e.g., basedupon the quality, and/or success rate of the physician, the benefits andany incentives available from his or her insurance policy). Embodimentscan also facilitate the individual's preparing for the treatment itselfso he or she can be a very informed patient, maximizing the benefits ofhis treatment by properly complying with the recovery and rehabilitationinstructions; assisting him with the logistics, medical appointmentand/or other arrangements of traveling to the destination of his or herchoice for surgery or other major medical intervention (e.g., if it isnot located in the patient's home area).

In an embodiment herein, there can be an evaluation (by the computerusing one or more pre-programmed models) of the received informationabout the individual regarding his or her initial diagnosis, diseasecondition and/or severity, co-morbidity, other clinical information,demographic information, statistical information, comparative treatmenteffectiveness information and/or other relevant information, as well asany combination of these kinds of information, against a knowledge basecontaining information about the appropriateness of various availabletreatments, their possible complications and/or prognosis for recoveryfor the individual.

In another embodiment, there can be an evaluation of the availablealternative treatments judged suitable for the individual againstinformation received about the individual's insurance coverage,deductible, incentives if any, and/or any other suitable informationsufficient for cost-benefit analysis.

In another embodiment, there can be computer directed information andpre-programmed education dispensed to the individual regarding his orher available treatment options, possibility of complications andprognosis for recovery for each treatment option.

In a further embodiment, there can be computer managed matching andinstructions about meeting a surgeon or alternative treatment physicianregarding a final treatment path selection.

In another embodiment, there can be a computer managed counselingregarding the final treatment choice once it is made and a cost-benefitanalysis about receiving the chosen treatment from a list of possiblelocations and suitable physician to maximize the medical benefit at anoptimum cost to the individual.

In yet another embodiment, there can be computer assisted arrangementsto help the individual with the logistics, medical appointment, and/orother arrangements of traveling to the destination of his or her choicefor the surgery or other treatment (e.g., if the destination is notlocated in the patient's home area).

Though the embodiments herein pertain to method, machine, manufacture,composition of matter, article, and improvements thereto, to besuccinct, consider representatively a method of assisting an individualsuffering from a serious ailment who has received an initial diagnosisof needing surgical or other invasive treatment(s) and who isconsequently going to make an informed decision about, or agree to, theremaining course of his treatment(s). More specifically, considercomputer related and implemented systems relating to a capability ofautomatically analyzing his disease condition to determine if comparablealternate treatment(s) to surgery are available, if such alternatetreatments are covered by his benefit plan and in some embodiments, acapability of automatically guiding the individual through the necessaryeducation, information, and a guidance process so he or she can make aninformed decision in consultation with his surgeon or physician, whilein other embodiments, assisting the individual in making a finalcost-benefit analysis, choosing the location and physician to receivetreatments from, as well as arranging for his or her travel logisticsand medical appointments.

Embodiments can implement a capability of assisting an individual choosea final course of his treatment and travel to any location to receivethe treatment, as exemplified above. Embodiments may be distinct or incombination with clinical screening or matching systems, such assuitability of surgical treatment(s) in view of the individual'sdemographic and/or medical conditions, including severity of disease,co-morbidity, and other factors. Embodiments can provide guidance,scheduling, education, information and counseling about availablealternate treatments, if any, including recovery prospects andprobability of complications of each treatment. There shall also be acapability of performing appropriate cost benefit analysis given thelimits and any incentives of the insurance policy of the individual. Insome embodiments, there shall also be a capability of physicianappointment, treatment scheduling, ticketing and other logistics oftraveling if the final treatment is to be received from a location awayfrom the individual's home area.

As illustrated in FIG. 17, some embodiments can be represented by a flowin which an individual receives guidance, education, counseling, costbenefit analysis, treatment, physician selection, scheduling, and travelservice. As should also be noted with respect to FIG. 17, an embodimentcan have a capability of resulting in an effective management of theprocess of receiving guidance, education, counseling, cost benefitanalysis, treatment, physician selection, scheduling, and travelservices.

Consider too that for an embodiment to properly manage the process asexemplified above, the system should receive appropriate amounts andtypes of data. While the types and amounts of data will reflect to adegree the particular embodiment or implementation at preferred, and canvary from time to time based on the contemporary state of understandingof the relative efficacy of the various types of treatment, includingimproved understanding of human physiology and development of newertreatments, in one embodiment, there can be a capability of processingand/or transforming data corresponding to the individual's diseaseseverity and other clinical information, demographic information,statistical information, other relevant information, as well as anycombination of these kinds of information.

Embodiments herein, again, can be implemented via a web site linking thecomputer system with another computer system corresponding to theindividual. A further embodiment can implement one of the embodimentsherein as a prerequisite to honoring an insurance claim related to thetreatment or procedure, and there can be computer-to-computercommunication with an insurance computer system to carry out thisfunction.

Accordingly, though the embodiments herein pertain to process, machine,manufacture, or composition of matter, and improvements, to be succinct,consider representatively in this case an apparatus comprising: a firstcomputer system comprising a digital computer operably associated withan input device, a memory, and an output device, the computer programmedto carry out operations including: loading the memory with informationabout surgical and non-surgical treatments available human ailments,including corresponding possibilities of complications and prognosis forrecovery from each treatment for the ailment as a function ofco-morbidity and severity; loading the memory with educational andinformational modules about alternate treatment choices for each of theailments and at least one corresponding possibility of a complicationand a prognosis for recovery; loading the memory with price, quality,and outcome information about treatment facilities and associatedphysicians where each of the treatment choices is available; receivingat the computer, from information input at said input device, datacorresponding to an individual's disease, initial diagnosis, medicalcondition including co-morbidity and severity information, demographicsinformation, statistical information, or any combination of theinformation plus information about any insurance or other benefitcoverage limits and incentives of the individual; processing the datawith the computer so as to produce a determination of whether theindividual suffers from a preference sensitive condition; and producing,at said output device, output disclosing the determination.

In another perspective, there can be an apparatus comprising: a firstcomputer system comprising a digital computer operably associated withan input device, a memory, and an output device, the computer programmedto carry out operations including: loading the memory with informationabout surgical and non-surgical treatments available human ailments,including corresponding possibilities of complications and prognosis forrecovery from each treatment for the ailment as a function ofco-morbidity and severity; loading the memory with educational andinformational modules about alternate treatment choices for each of theailments and at least one corresponding possibility of a complicationand a prognosis for recovery; loading the memory with price, quality,and outcome information about treatment facilities and associatedphysicians where each of the treatment choices is available; receivingat the computer, from information input at said input device, datacorresponding to an individual's disease, initial diagnosis, medicalcondition including co-morbidity and severity information, demographicsinformation, statistical information, comparative treatment efficacyinformation or any combination of the information plus information aboutany insurance or other benefit coverage limits and incentives of theindividual; processing the data with the computer so as to produce adetermination of whether the individual suffers from a non-preferencesensitive condition; and producing, at said output device, outputdisclosing the determination.

In such embodiments, the apparatus can further include a second computersystem comprising a second digital computer operably associated with asecond input device, a second memory, and a second output device, thesecond computer programmed to carry out operations including: receivingat least some of the output disclosing the determination.

Also in such embodiments, as mentioned above, the communicatingoperation is carried out via a web site.

And in such embodiments, the first computer can generate further outputreferring an individual to a surgical consultant associated with asurgery corresponding to the determination.

Notably in such embodiments, the computer can generate other output soas to facilitate the individual choosing a most cost effective locationand surgeon for a surgery corresponding to the determination, said otheroutput reflecting respective measures of quality and success rate of asurgeon, any benefit and any incentive available from insurance for thesurgery or other major medical interventions.

In such embodiments, the computer can generate additional output so asto facilitate logistics and arrangements for traveling to thedestination of chosen by the individual for a surgery or other majormedical interventions corresponding to the determination.

And in such embodiments, the computer can generate yet further outputincluding a counseling and education session for each of the treatments.

Also in such embodiments, the session can comprise providing informationregarding the terms of insurance coverage, risk of complication andprognosis for recovery from each of the alternatives.

In such embodiments, the session can include a selection of a finaltreatment for a surgery or other major medical interventionscorresponding to the determination, including facilitating a choice of amost cost effective location and medical provider for the intervention.

And in some embodiments, the selection can be formulated based upon atleast one of: quality and success rate of a medical provider, benefitsand any incentives available from an insurance policy.

Also in such embodiments, if the selection is for a non-surgicaltreatment, there can be a generating of output helping the individualchoose the most cost effective location and physician for the selectedtreatment.

Embodiments herein, again, can be viewed from the perspective of anarticle, e.g., as an article comprising: computer-readable mediatangibly embodying a program of instructions executable by a computer toperform the operations of: receiving data corresponding to: anindividual's disease, diagnosis, severity and co-morbidity information,demographics information, statistical information, or any combinationthereof; data corresponding to availability of alternate treatments, atleast one possibility of complication, at least one prognosis forrecovery from each said treatment; at least one treatment option; price,quality, and outcome information corresponding to at least one treatmentfacility and at least one associated physician; and coverage, limit, andany incentive of the individual's insurance; processing the data todetermine first if the individual suffers from a preference sensitivecondition; and producing output disclosing the determination.

And again, embodiments herein can be viewed from the standpoint of aprocess (i.e., method) such as a method of using an apparatus, themethod comprising: providing first computer system comprising a digitalcomputer operably associated with an input device, a memory, and anoutput device; loading the memory with information about surgical orother major medical interventions and non-surgical treatments availablefor human ailments, including corresponding possibilities ofcomplications and prognosis for recovery from each treatment for theailment as a function of co-morbidity and severity; loading the memorywith educational and informational modules about alternate treatmentchoices for each of the ailments and at least one correspondingpossibility of a complication and a prognosis for recovery; loading thememory with price, quality, and outcome information about treatmentfacilities and associated physicians where each of the treatment choicesis available; receiving at the computer, from information input at saidinput device, data corresponding to an individual's disease, initialdiagnosis, medical condition including co-morbidity and severityinformation, demographics information, statistical information, or anycombination of the information plus information about any insurance orother benefit coverage limits and incentives of the individual;processing the data with the computer so as to produce a determinationof whether the individual suffers from a preference sensitive condition;and producing, at said output device, output disclosing thedetermination.

Also in such embodiments can be viewed as another method of using anapparatus, the method comprising: providing a first computer systemcomprising a digital computer operably associated with an input device,a memory, and an output device; loading the memory with informationabout surgical and non-surgical treatments available human ailments,including corresponding possibilities of complications and prognosis forrecovery from each treatment for the ailment as a function ofco-morbidity and severity; loading the memory with educational andinformational modules about alternate treatment choices for each of theailments and at least one corresponding possibility of a complicationand a prognosis for recovery; loading the memory with price, quality,and outcome information about treatment facilities and associatedphysicians where each of the treatment choices is available; receivingat the computer, from information input at said input device, datacorresponding to an individual's disease, initial diagnosis, medicalcondition including co-morbidity and severity information, demographicsinformation, statistical information, or any combination of theinformation plus information about any insurance or other benefitcoverage limits and incentives of the individual; processing the datawith the computer so as to produce a determination of whether theindividual suffers from a non-preference sensitive condition; andproducing, at said output device, output disclosing the determination.

So to overview, with respect to FIG. 17, there can be a machine, method,article, illustratively the machine including: providing first computersystem comprising a digital computer operably associated with an inputdevice, a memory, and an output device; loading the memory withinformation about surgical or other major medical interventions andnon-surgical treatments available for human ailments, includingcorresponding possibilities of complications and prognosis for recoveryfrom each treatment for the ailment as a function of co-morbidity andseverity; loading the memory with educational and informational modulesabout alternate treatment choices for each of the ailments and at leastone corresponding possibility of a complication and a prognosis forrecovery; loading the memory with price, quality, and outcomeinformation about treatment facilities and associated physicians whereeach of the treatment choices is available; receiving at the computer,from information input at said input device, data corresponding to anindividual's disease, initial diagnosis, medical condition includingco-morbidity and severity information, demographics information,statistical information, comparative treatment effectiveness informationor any combination of the information plus information about anyinsurance or other benefit coverage limits and incentives of theindividual; processing the data with the computer so as to produce adetermination, the determination including a determination of whetherthe individual suffers from a non-preference sensitive condition or apreference sensitive condition; and producing, at said output device,output disclosing the determination.

Turn now to FIG. 18, for yet further embodiments.

With respect to an individual suffering from an ailment who has receivedan initial diagnosis of, or otherwise desires, surgical or other majormedical intervention(s) and who is consequently going to make aninformed decision about, or agree to, the remaining course of his or hertreatment(s), consider embodiments applicable to the process of his orher understanding and decision making. In one example, consider suchdecision making as having careful guidance, counseling, education,information, and other assistances, e.g., at layman levels, so his orher choices can be optimized based upon available treatment options,risks of complications and/or prognosis for improving the medicalcondition from each possible treatment. Consider also that he or sheneeds to properly understand the limit of his or her insurance coverageand any incentives therein, including available choice of physician orother health practitioner and alternate locations to receive treatments,an appropriate cost-benefits analysis, or other such information. Anembodiment herein can facilitate an individual's understanding anddecision making applicable to such a situation, e.g., by first using theinitial diagnosis, disease condition and severity, co-morbidity, otherclinical information, demographic information, statistical information,comparative treatment efficacy information and/or other relevantinformation, as well as any combination of these kinds of information,and then judging if the individual's condition is a preference sensitiveone, i.e., if he or she suffers from a condition for which appropriatealternate treatment(s) to surgery or other major medical interventionsare available with comparable prognosis for improving the medicalcondition, and how much he is covered for each alternate treatment underthe terms of his or her insurance policy; and then, if his condition isjudged not to be preference sensitive, referring him or her to anappropriate surgical consultant. Embodiments can follow this withappropriate counseling about the specific surgery or other major medicalinterventions recommended by the treatment consultant so the individualcan choose the most cost effective location and/or medical provider forthe surgery or other major medical intervention, e.g., based upon thequality and success rate of the medical provider, available outcomesstatistics or other information about the expected prognosis forimproving the medical condition of the specific surgery or other majormedical interventions, the benefits and any incentives available fromhis or her insurance policy. Embodiments can also facilitate theindividual's preparing for the surgery or other major medicalintervention itself, maximizing the benefits of the surgery or othermajor medical intervention by properly complying with pre and posttreatment instructions; assisting with the logistics and otherarrangements of traveling to the destination (e.g., of his or herchoice) for surgery or other major medical intervention (e.g., if it isnot located in the patient's home area); on the other hand, if theindividual's condition is judged to be preference sensitive, thenguiding him or her through an appropriate counseling and educationprocess for each of the alternative treatments that is available underthe terms of his or her insurance or other benefit plan coverage, therisks of complications and outcomes statistics or other informationabout the expected prognosis for improving the medical condition fromeach of the alternatives, and otherwise preparing him or her to discusstreatment options next in an informed manner with the physician or otherhealth counselor, e.g., to select a final course of treatment; then ifthe selection is for a surgical or other major medical interventionpath, as before, helping him or her choose the most cost effectivelocation and/or medical provider for the treatment (e.g., based upon thequality and/or success rate of the medical provider, available outcomesstatistics or other information about the expected prognosis forimproving the medical condition of the specific surgery or other majormedical intervention, the benefits and any incentives available from hisor her insurance policy). Embodiments can also facilitate theindividual's preparing for the surgery or other major medicalintervention itself so he or she can be an informed patient, maximizingthe benefits of his surgery by or other major medical interventionsproperly complying with pre and post treatment instructions; assistinghim or her with the logistics and other arrangements of traveling to thedestination (e.g., of his or her choice) of his or her choice forsurgery or other major medical intervention (e.g., if it is not locatedin the patient's home area); on the other hand, if the treatment pathselected is non-surgical in nature, then helping the individual choosethe most cost effective location, and/or the physician or other healthpractitioner for the selected treatment (e.g., based upon the quality,and/or success rate of the physician and/or health practitioner, outcomestatistic(s) or other information about the expected prognosis forimproving the medical condition of the specific treatment, the benefitsand any incentives available from his or her insurance policy).Embodiments can also facilitate the individual's preparing for thetreatment itself so he or she can be an informed patient, maximizing thebenefits of his treatment by properly complying with the recovery andrehabilitation instructions; assisting him with the logistics, medicalappointment and/or other arrangements of traveling to the destination ofhis or her choice for treatment (e.g., if it is not located in thepatient's home area).

In an embodiment herein, there can be an evaluation (by the computerusing one or more pre-programmed models) of the received informationabout the individual regarding any initial diagnosis, condition and/orseverity of the ailment, co-morbidity, other clinical information,demographic information, statistical information, and/or other relevantinformation, as well as any combination of these kinds of information,against a knowledge base containing information about theappropriateness of various available treatments, their possiblecomplications and/or outcomes statistics or other information about theexpected prognosis for improving the medical condition of the potentialtreatments.

In another embodiment, there can be an evaluation of the availablealternative treatments judged suitable for the individual againstinformation received about the individual's insurance coverage,deductible, incentives if any, and/or any other suitable informationsufficient for cost-benefit analysis.

In another embodiment, there can be computer directed information andpre-programmed education dispensed to the individual regarding his orher available treatment options, possibility of complications andoutcomes statistics or other information about the expected prognosisfor improving the medical condition for each treatment option.

In a further embodiment, there can be computer managed matchinginstructions about meeting a surgeon or alternative treatment physicianor other health practitioner regarding a final treatment path selection.

In another embodiment, there can be a computer managed counselingregarding the final treatment choice once it is made and a cost-benefitanalysis about receiving the chosen treatment from a list of possiblelocations and suitable physician or other health practitioner tomaximize the medical benefit at an optimum cost to the individual.

In yet another embodiment, there can be computer assisted arrangementsto help the individual with the logistics, medical appointment, and/orother arrangements of traveling to the destination of his or her choicefor the surgery or other treatment (e.g., if the destination is notlocated in the patient's home area).

Though the embodiments herein pertain to method, machine, manufacture,composition of matter, article, and improvements thereto, to besuccinct, consider representatively a method of assisting an individualsuffering from an ailment who has received an initial diagnosis of, orotherwise desires surgical or other invasive treatment(s) and who isconsequently going to make an informed decision about, or agree to, theremaining course of his treatment(s). More specifically, considercomputer related and implemented systems relating to a capability ofautomatically analyzing his disease condition to determine if comparablealternate treatment(s) to surgery are available, if such alternatetreatments are covered by his benefit plan and in some embodiments, acapability of automatically guiding the individual through the necessaryeducation, information, and a guidance process so he or she can make aninformed decision in consultation with his surgeon or physician or otherhealth practitioner, while in other embodiments, assisting theindividual in making a final cost-benefit analysis, choosing thelocation and physician or other health practitioner to receivetreatments from, as well as arranging for his or her travel logisticsand medical appointments.

Embodiments can implement a capability of assisting an individual choosea final course of his treatment and travel to any location to receivethe treatment, as exemplified above. Embodiments may be distinct or incombination with clinical screening or matching systems, such assuitability of surgical or other major medical interventions in view ofthe individual's demographic and/or medical conditions, includingseverity of ailment, co-morbidity, and other factors. Embodiments canprovide guidance, scheduling, education, information and counselingabout available alternate treatments, if any, including outcomesstatistics or other information about the expected prognosis forimproving the medical condition and probability of complications of eachtreatment. There shall also be a capability of performing appropriatecost benefit analysis given the limits and any incentives of theinsurance policy of the individual. In some embodiments, there shallalso be a capability of physician or other health practitionerappointment, treatment scheduling, ticketing and other logistics oftraveling if the final treatment is to be received from a location awayfrom the individual's home area.

As illustrated in FIG. 18, some embodiments can be represented by a flowin which an individual receives guidance, education, counseling, costbenefit analysis, treatment, physician or other health practitionerselection, scheduling, and travel services.

As should also be noted with respect to FIG. 18, an embodiment can havea capability of resulting in an effective management of the process ofreceiving guidance, education, counseling, cost benefit analysis,treatment, physician or other health practitioner selection, scheduling,and travel services.

Consider too that for an embodiment to properly manage the process asexemplified above, the system should receive appropriate amounts andtypes of data. While the types and amounts of data will reflect to adegree the particular embodiment or implementation as may be preferred,and can vary from time to time based on the contemporary state ofunderstanding of the relative efficacy of the various types oftreatment, including improved understanding of human physiology anddevelopment of newer treatments, in one embodiment, there can be acapability of processing and/or transforming data corresponding to theindividual's severity of ailment and other clinical information,demographic information, statistical information, comparative treatmentefficacy information, other relevant information, as well as anycombination of these kinds of information.

Embodiments herein can be implemented via a web site linking thecomputer system with another computer system corresponding to theindividual. A further embodiment can implement one of the embodimentsherein as a prerequisite to honoring an insurance claim related to thetreatment or procedure, and there can be computer-to-computercommunication with an insurance computer system to carry out thisfunction.

Accordingly, though the embodiments herein pertain to process, machine,manufacture, or composition of matter, and improvements, to be succinct,consider representatively an apparatus comprising: a first computersystem comprising a digital computer operably associated with an inputdevice, a memory, and an output device, the computer programmed to carryout operations including: loading the memory with information aboutsurgical and non-surgical treatments available for various humanailments, including corresponding possibilities of complications andoutcomes statistics or other information about the expected prognosisfor improving the medical condition from each treatment for the ailmentas a function of co-morbidity and severity; loading the memory witheducational and informational modules about alternate treatment choicesfor each of the ailments and at least one corresponding possibility of acomplication and a prognosis for improving the medical condition;loading the memory with price, quality, and outcome information abouttreatment facilities and at least one associated health practitionerwhere each of the treatment choices is available; receiving at thecomputer, from information input at said input device, datacorresponding to an individual's ailment, any initial diagnosis, medicalcondition including co-morbidity and severity information, demographicsinformation, statistical information, or any combination of theinformation plus information about any insurance or other benefitcoverage limits and incentives of the individual; processing the datawith the computer so as to produce a determination of whether theindividual suffers from a preference sensitive condition; and producing,at said output device, output disclosing the determination.

In another view, illustratively, there can be an apparatus comprising: afirst computer system comprising a digital computer operably associatedwith an input device, a memory, and an output device, the computerprogrammed to carry out operations including: loading the memory withinformation about surgical and non-surgical treatments available forvarious human ailments, including corresponding possibilities ofcomplications and outcomes statistics or other information about theexpected prognosis for improving the medical condition from eachtreatment for the ailment as a function of co-morbidity and severity;loading the memory with educational and informational modules aboutalternate treatment choices for each of the ailments and at least onecorresponding possibility of a complication and a prognosis forimproving the medical condition; loading the memory with price, quality,and outcome information about treatment facilities and at least oneassociated health practitioner where each of the treatment choices isavailable; receiving at the computer, from information input at saidinput device, data corresponding to an individual's ailment, any initialdiagnosis, medical condition including co-morbidity and severityinformation, demographics information, statistical information, or anycombination of the information plus information about any insurance orother benefit coverage limits and incentives of the individual;processing the data with the computer so as to produce a determinationof whether the individual suffers from a non-preference sensitivecondition; and producing, at said output device, output disclosing thedetermination.

Such embodiments can further include a second computer system comprisinga second digital computer operably associated with a second inputdevice, a second memory, and a second output device, the second computerprogrammed to carry out operations including: receiving at least some ofthe output disclosing the determination.

Also, there can be embodiments wherein the communicating operation iscarried out via a web site.

And there can be embodiments wherein the first computer generatesfurther output referring an individual to a surgical or other majormedical intervention consultant associated with a surgery or other majormedical intervention corresponding to the determination.

Note that there can be embodiments wherein the computer generates otheroutput so as to facilitate the individual choosing a most cost effectivelocation and surgeon for a surgery corresponding to the determination,said other output reflecting at least one of a measure of quality of asurgeon, a success rate of the surgeon, an outcome statistic for asurgery, a prognosis for improving the medical condition from thespecific surgery, or any combination thereof, and any benefit and anyincentive available from insurance or any other source for the surgery.

Also such embodiments can be carried out such that the computergenerates additional output so as to facilitate logistics andarrangements for traveling to the destination of chosen by theindividual for a surgery corresponding to the determination.

And there can be embodiments wherein the computer generates yet furtheroutput including a counseling and education session for each of thetreatments.

Also in such embodiments, the session can comprise providing informationregarding the terms of insurance coverage, risk of complication,prognosis for improving the medical condition, or combination thereoffor improving the medical condition from each of the alternatives.

There can be embodiments wherein the session includes a selection of afinal treatment for a surgery corresponding to the determination,including facilitating a choice of a most cost effective location andsurgeon for the surgery or other major medical intervention.

And there can be embodiments wherein the selection is formulated basedupon at least one of: quality and success rate of a surgeon or othermajor medical intervention provider, benefits and any incentivesavailable from an insurance policy or any other source.

Further, embodiments can be such that if the selection is for anon-surgical treatment, generating output helping the individual choosethe most cost effective location and health practitioner for theselected treatment.

Viewed now from the perspective of an article, this or really anyembodiment herein can be viewed as an article. So, illustratively, therecan be an embodiment of an article comprising: a computer-readable mediatangibly embodying a program of instructions executable by a computer toperform the operations of: receiving data corresponding to: anindividual's ailment, any diagnosis, severity and co-morbidityinformation, demographics information, statistical information,comparative treatment efficacy information or any combination thereof;data corresponding to availability of alternate treatments, at least onepossibility of complication, at least one prognosis for improving themedical condition from each said treatment; at least one treatmentoption; price, quality, and outcome information corresponding to atleast one treatment facility and at least one associated healthpractitioner; and coverage, limit, and any incentive of the individual'sinsurance or of any other source; processing the data to determine firstif the individual suffers from a preference sensitive condition; andproducing output disclosing the determination.

Viewed now from the perspective of a method, illustratively, there canbe a method of using an apparatus, the method comprising: providingfirst computer system comprising a digital computer operably associatedwith an input device, a memory, and an output device; loading the memorywith information about surgical and non-surgical treatments availablefor human ailments, including corresponding possibilities ofcomplications and prognosis for improving the medical condition fromeach treatment for the ailment as a function of co-morbidity andseverity; loading the memory with educational and informational modulesabout alternate treatment choices for each of the ailments and at leastone corresponding possibility of a complication and a prognosis forimproving the medical condition; loading the memory with price, quality,and outcome information about treatment facilities and at least oneassociated health practitioner where each of the treatment choices isavailable; receiving at the computer, from information input at saidinput device, data corresponding to an individual's ailment, any initialdiagnosis, medical condition including co-morbidity and severityinformation, demographics information, statistical information, or anycombination of the information plus information about any insurance orother benefit coverage limits and incentives of the individual;processing the data with the computer so as to produce a determinationof whether the individual suffers from a preference sensitive condition;and producing, at said output device, output disclosing thedetermination.

In another way of thinking, there can be a method of using an apparatus,the method comprising: providing first computer system comprising adigital computer operably associated with an input device, a memory, andan output device, the computer programmed to carry out operationsincluding: loading the memory with information about surgical andnon-surgical treatments available for various human ailments, includingcorresponding possibilities of complications and prognosis for improvingthe medical condition from each treatment for the ailment as a functionof co-morbidity and severity; loading the memory with educational andinformational modules about alternate treatment choices for each of theailments and at least one corresponding possibility of a complicationand a prognosis for improving the medical condition; loading the memorywith price, quality, and outcome information about treatment facilitiesand at least one associated health practitioner where each of thetreatment choices is available; receiving at the computer, frominformation input at said input device, data corresponding to anindividual's ailment, any initial diagnosis, medical condition includingco-morbidity and severity information, demographics information,statistical information, or any combination of the information plusinformation about any insurance or other benefit coverage limits andincentives of the individual; processing the data with the computer soas to produce a determination of whether the individual suffers from anon-preference sensitive condition; and producing, at said outputdevice, output disclosing the determination.

So to overview, with respect to FIG. 108 there can be a machine, method,article, illustratively the machine including: a method of using anapparatus, the method including: providing first computer systemcomprising a digital computer operably associated with an input device,a memory, and an output device; loading the memory with informationabout surgical and non-surgical treatments available for various humanailments, including corresponding possibilities of complications andprognosis for improving the medical condition from each treatment forthe ailment as a function of co-morbidity and severity; loading thememory with educational and informational modules about alternatetreatment choices for each of the ailments and at least onecorresponding possibility of a complication and a prognosis forimproving the medical condition; loading the memory with price, quality,and outcome information about treatment facilities and associatedphysician or other health practitioners where each of the treatmentchoices is available; receiving at the computer, from information inputat said input device, data corresponding to an individual's ailment, anyinitial diagnosis, medical condition including co-morbidity and severityinformation, demographics information, statistical information,comparative treatment efficacy information or any combination of theinformation plus information about any insurance or other benefitcoverage limits and incentives of the individual; processing the datawith the computer so as to produce a determination, the determinationincluding a determination of whether the individual suffers from anon-preference sensitive condition or a preference sensitive condition;and producing, at said output device, output disclosing thedetermination; with said determination, appropriately educating andinforming the individual enough so he or she can discuss his or hertreatment options in an informed manner with a surgeon, physician, orother health professional and make the final selection for his or hertreatment; performing an appropriate cost-benefits analysis to assistthe individual select a destination and a surgeon, physician or otherhealth practitioner to receive his or her treatment; securing thenecessary medical appointment and making appropriate travel and otherlogistical arrangements for the individual.

Accordingly, though the embodiments herein pertain to process, machine,manufacture, or composition of matter, and improvements, to be succinct,consider representatively a method of using an apparatus, the methodincluding: storing data of a population in memory; computing, by acomputer accessing the data stored in the memory, a probability of atleast one future medical treatment needed by at least one individualhaving data in the data of a population; ascribing, by the computerapplying the computed probabilities, each said individual with one of aplurality of risk stratifications for each said future medicaltreatment; and producing, by the computer communicating to an outputdevice, output including at least one said ascribed individual inassociation with the one of the risk stratifications.

In some embodiments, the data of the population includes one or more ofpersonal data, demographic data, health data, behavioral data,demographic data, payer data, insurance data, governmental data,comparative treatment efficacy data.

Note that in some embodiments, the at least one medical treatment caninclude a surgical treatment and/or a non-surgical treatment, and thatin some embodiments, the at least one medical treatment can include atreatment for which there is an alternative treatment determined by thecomputer accessing the database.

Some embodiments can further include: determining, by the computeraccessing the memory, whether at least one alternative treatment for thefuture medical treatment may be appropriate for the individual; andproducing, at the output device, output tailored responsive to thedetermination of whether said alternative treatment may be appropriatefor the individual.

Some embodiments can further include: forming, by the computer accessingthe data stored in the memory, an association of travel by an individualand a health consequence as a result of the travel by the individual;and generating, at the output device, output including the association.

And some embodiments can further include: forming, by a computeraccessing the data stored in the memory, an association of travel by anindividual and a health consequence as a result of the travel by theindividual; and generating, at the output device, output including theassociation.

From another perspective, illustratively, there can be a method of usingan apparatus, the method including: storing data of a population inmemory; computing, by a computer accessing the data stored in thememory, a probability of at least one future medical treatment needed byan individual having data in the data of a population; determining, bythe computer accessing the memory, whether at least one alternativetreatment for the future medical treatment may be appropriate for theindividual; and producing, at an output device operably associated withthe computer, output tailored responsive to the determination of whethersaid alternative treatment may be appropriate for the individual.

Some embodiments can further include: storing medical provider data inmemory, and wherein the output includes provider information associatedwith at least one said treatment; scheduling, responsive to aninstruction of the individual received from an input device, anappointment for a provider corresponding to the provider information,and generating, at the output device, information including thescheduled appointment; and/or generating, with the computer, travelinformation for the individual to carry out the scheduled appointment.

Also, some embodiments can further include: generating, with thecomputer, logistical information for the individual to carry out thescheduled appointment; generating, with the computer, travel informationfor the individual to carry out an appointment corresponding to at leastone said treatment; and/or generating, with the computer, logisticalinformation for the individual to carry out at least one said treatment.

In some embodiments, the data of a population can include one or more ofinsurance claims data, governmental claims data, insurance benefitsdata, governmental benefits data, and/or geographical data.

With respect to some embodiments, the output can include one or more of:educational material which references at least one of said treatments, arisk indicator, a prognosis of recovery, an insurance benefit statement,a governmental benefit statement, an incentive statement, and or a coststatement, any of foregoing associated with at least one of saidtreatments.

Some embodiments can be carried out with the output including multimediadata, video data, audio data, and/or animation data.

Embodiments can be carried out by receiving information from theindividual at a web server, providing the output to the individual via aweb site, and/or over a network.

Note that in some embodiments, the provider data can include at leastone provider associated with at least one said treatment, e.g.,personnel qualifications, experience statements, a treatment successrate, a quality rating, insurance approval data, etc.

Also, embodiments can further include determining, by the computeraccessing the memory, whether at least one alternative treatment for thefuture medical treatment may be appropriate for the individual; andproducing, at the output device, output tailored responsive to thedetermination of whether said alternative treatment may be appropriatefor the individual.

And embodiments can be viewed from a different perspective, such as amethod of using an apparatus, the method including: storing client datain memory; forming, by a computer accessing the data stored in thememory, an association of travel by an individual and a healthconsequence as a result of the travel by the individual; and generating,at an output device operably associated with the computer, outputincluding the association.

In any of the embodiments, the forming can include one or more ofdetermining: a travel distance, a travel duration, an amount of timeother than a travel time, an amount of time of rest after traveling, anamount of time to wait after travel before commencing a medicalprocedure, and/or an amount of time to wait before travel after amedical procedure, a safety score.

Embodiments can also be responsive to a method of travel.

Note too that the embodiments herein are a prophetic teaching andalthough only a few exemplary embodiments have been described in detailherein, those skilled in the art will readily appreciate that manymodifications are possible in the exemplary embodiments withoutmaterially departing from the novel predictions or teachings andadvantages herein. Please understand that features illustrated in theFigure and texts are interwoven rather than integral and sequential,e.g., as in sub-steps. Accordingly, all such modifications are intendedto be included within the scope herein, and if used herein,means-plus-function language is intended to cover the structuresdescribed herein as performing the recited function and not onlystructural equivalents, but also equivalent structures. Thus, forexample, although a nail and a screw may not be structural equivalentsin that a nail employs a cylindrical surface to secure wooden partstogether, whereas a screw employs a helical surface, in the environmentfastening wooden parts, a nail and a screw can be equivalent structures.

1-85. (canceled)
 86. Apparatus to produce and disseminate output relatedto comparative medical treatment effectiveness for a population havingdifferent medical treatments, the apparatus including: a memoryconfigured to store, for a population having different medicaltreatments, each member of the population's medical treatment data forat least one of a disease, an ailment, and a disability andcorresponding cost data for the medical treatment, the memory storingsaid data; a digital computer, which: accesses the memory to obtain thestored data and then processes the stored data, including: grouping thedata according to types of the medical treatments received to producegroupings for each said at least one of the disease, the ailment, andthe disability; computing, from the groupings of the types of treatmentsreceived, to produce a measure of comparative cost effectiveness of themedical treatments; and applying the measure to the population produce acomparative effectiveness of the medical treatments; generating outputwhich includes the produced the comparative effectiveness of the medicaltreatments; and an output device which disseminates the output whichincludes the produced comparative effectiveness of the medicaltreatments.
 87. The apparatus of claim 86, wherein the cost dataincludes pre-treatment cost data and post-treatment cost data.
 88. Theapparatus of claim 86, wherein the memory stores each member of thepopulation's existing health status prior to the medical treatment, andwherein the existing health status is used in the computing of themeasure of the comparative cost effectiveness.
 89. The apparatus ofclaim 86, wherein the memory stores each member of the population'scontinuing health status subsequent to the medical treatment, andwherein the continuing health status is used in the computing of themeasure of the comparative cost effectiveness.
 90. The apparatus ofclaim 86, wherein said at least one of the disease, the ailment, and thedisability comprises at least two of the disease, the ailment, and thedisability.
 91. The apparatus of claim 86, wherein said at least one ofthe disease, the ailment, and the disability comprises at least three ofthe disease, the ailment, and the disability.
 92. The apparatus of claim88, wherein the existing health status prior to the medical treatmentincludes personal health data.
 93. The apparatus of claim 88, wherein:the computer determines, by accessing the data in memory, a safety scorein association of travel by at least one member of the population andthen generates output including the determination, and then stores theoutput including the determination in the memory; and the output devicedisseminates said output including the determination
 94. The apparatusof claim 92, wherein: the computer determines, by accessing the data inmemory, a safety score in association of travel by at least one memberof the population and then generates output including the determination,and then stores the output including the determination in the memory;and the output device disseminates said output including thedetermination.
 95. The apparatus of claim 88, wherein the existinghealth status prior to the medical treatment includes personalbehavioral data.
 96. The apparatus of claim 95, wherein: the computerdetermines, by accessing the data in memory, a safety score inassociation of travel by at least one member of the population and thengenerates output including the determination, and then stores the outputincluding the determination in the memory; and the output devicedisseminates said output including the determination.
 97. A method ofusing an apparatus to produce and disseminate output related tocomparative medical treatment effectiveness for a population havingdifferent medical treatments, the method including: storing, in memory,for a population having different medical treatments, each member of thepopulation's medical treatment data for at least one of a disease, anailment, and a disability and corresponding cost data for the medicaltreatment, the memory storing said data; accessing, with a digitalcomputer, the memory to obtain the stored data and then processing thestored data, including: grouping the data according to types of themedical treatments received to produce groupings for each said at leastone of the disease, the ailment, and the disability; computing, from thegroupings of the types of treatments received, to produce a measure ofcomparative cost effectiveness of the medical treatments; and applyingthe measure to the population produce a comparative effectiveness of themedical treatments; generating output which includes the produced thecomparative effectiveness of the medical treatments; and disseminating,with an output device, the output which includes the producedcomparative effectiveness of the medical treatments.